ASTRO recently issued an analysis of the 2011 Physician Fee Schedule's impact on radiation oncology. You can read the full report here, but I've outlined some of the highlights for you below.
Changes Result in 1% Decline in Allowed Charges
As part of the rule making process, CMS is required to estimate the impact of the 2011 changes to RVUs on each physician specialty. According to their calculations, radiation oncology can expect an overall decrease in payment of 1% in 2011. It is important to note that this change does not
include the 31% reduction of the conversion factor resulting from the Sustainable Growth Rate formula. However, as in the past, Congress is expected to roll back the cut before it takes effect.
The 1% reduction is the results of multiple factors. Starting in 2010, CMS began transitioning to an updated set of practice expense data. This change will have the effect of reducing radiation oncology payment by a total 9% by 2013. 2011 represents the second year of this phase in. Meanwhile the revision of the Medicare Economic Index (MEI) is helping to counteract these cuts. It actually contributed to a 4% increase in payment for radiation oncology this year.
ASTRO Anticipates 6.1% Reduction in the Conversion Factor
Although ASTRO expects Congress to intervene to roll back the 30.1% cut to the conversion factor, they still anticipate a 6.1% reduction to the conversion factor resulting from other adjustments. They estimate the final conversion factor for 2011 will be $33.1513 (versus $36.8729 for 2010).
Top Five Codes Billed By Radiation Oncology
A review of payment rates for the top five high volume radiation oncology services reveals a mixed bag. 77301 (Radiation dose plan IMRT), 77418 (Radiation Tx Delivery IMRT) and 77427 (Radiation Tx management x5) experienced cuts ranging from -0.1% to -20.9%. In contrast, payment for 77413 (Radiation treatment delivery) and 77414 (Radiation treatment delivery) were increased by 6.7% and 7.0% respectively.
More Analysis in our Upcoming Medicare Reimbursement Update
Overall these changes represent a continuation of the trend of declining payment for radiation oncology in the freestanding and physician office setting. We provide more code-by-code analysis as well as a comparison of payment in the hospital-based versus freestanding setting in our web conference on the 2011 Medicare payment rules. Listen to the recording